Autonomy, Role Ambiguity, and Collaborative Relationships Impact Novice Nurse Practitioner Turnover Intention in Primary Care

Sunday, 19 March 2017: 10:00 AM

Asefeh Faraz, PhD
School of Nursing, The George Washington University, Washington, DC, USA

The purpose of this study was to describe the individual characteristics, role acquisition and job satisfaction of novice nurse practitioners (NPs), and identify the factors associated with their successful transition and turnover intention in the first year of primary care (PC) practice. This research study was a descriptive, cross-sectional quantitative design conducted via online survey administered by Qualtrics. A national sample of NPs who had graduated from an accredited NP program and were practicing in a PC setting for 3-12 months participated in the study.

The study was comprised of a researcher-created demographic and background questionnaire and several psychometrically tested instruments: Psychological Empowerment Meaning Subscale, a modified Social Support Questionnaire Short Version (SSQ6), the Role Ambiguity Scale, Grundy’s Confidence Scale, The Misener Nurse Practitioner Job Satisfaction Scale, and the Anticipated Turnover Scale. Five open-ended questions were included at the end of the questionnaire to assess aspects of the workforce transition not otherwise captured.

The average participant (n=177) was female, 35 years old, Caucasian, married, and not presently supporting dependents. Results showed that 57.6% of the sample attended a traditional master’s program, 41.2% had six or more years of prior RN experience, and 90.4% reported having a workplace mentor whom they could ask questions. Professionally, the average participant held a master’s degree in nursing, is a family NP and works 40 or more hours per week. In addition, the following were the most commonly occurring characteristics of the sample: six or more years of previous RN experience; no prior healthcare related employment other than RN, and working in a private practice PC setting.

Variables showing significant relationships to turnover intention (p<.01) included: role ambiguity (-.51), professional autonomy (-.62), and quality of professional and interpersonal relationships (-.57). Multiple regression results indicated that turnover intention was significantly influenced by higher professional autonomy (b=-.44, t=-3.42, p=.001) and lower role ambiguity (b=-.20, t=-2.14, p=.03). The regression model explained approximately 48% of the variance in turnover intention for the sample.

Results could potentially aid employers in focusing their efforts on developing programs to increase professional autonomy and improve role clarification within their organizations, as well as routinely assess these factors in NPs they employ. Health care organizations should consider ensuring professional autonomy for novice NPs, while providing some level of formal orientation and support. Creating a practice environment that emphasizes professional autonomy of the NP is one in which mutual collaboration occurs and NPs are allowed to practice to the full extent of their education with clarified roles and responsibilities. This is essential for NP autonomy to flourish, thereby improving satisfaction and increasing retention.

Furthermore, greater clarity and increased awareness of other health care providers (HCPs) in the practice setting of the NP role is needed in many organizations. Employers may benefit from educating their staff, particularly other HCPs, about the role and scope of practice of NPs. Many are proponents of collaborative and inter-professional education to increase awareness and understanding among various HCPs at an earlier stage so that they may more effectively communicate in the workplace. NP transition-to-practice programs may be effective in decreasing role ambiguity, in particular through use of reflective journaling.

The first step in developing intervention programs is to understand the needs of the population. This study found that increasing professional autonomy and decreasing role ambiguity are critical to facilitating the successful transition of novice NPs in PC settings. The common denominator to accomplishing both of these goals is improving collaborative relationships in the practice setting. There are multiple campaigns underway to improve interprofessional collaborative practice, including recent recommendations by the IOM, Robert Wood Johnson Foundation (RWJF), and the Interprofessional Education Collaborative (comprised of AACN, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and Association of Schools of Public Health).

This research study demonstrated that greater professional autonomy in the workplace is a critical factor in turnover intention in novice NPs in the PC setting. Additionally, decreased role ambiguity is a strong predictor of turnover intention and should be an area of focus. Both of these factors may be influenced by collaborative relationships in the workplace. Further research is needed to evaluate the successful transition of novice NPs into the workforce to determine ways of providing adequate professional autonomy, decreasing role ambiguity, and how best to support them during the transitional period.